Atypical Bronchial Carcinoid Tumor Revealed by Liver Biopsy

Abstract

Bronchial carcinoid tumors develop from the Kulchitsky cells of the bronchial epithelium, which are stem cells with neuroendocrine properties. These tumors are divided into two types: typical forms and atypical forms, the latter being much rarer, more aggressive, and having a much higher probability of recurrence and distant metastasis. We report herein a rare case of an atypical lung carcinoid tumor metastatic to the liver. The patient is a 79-year-old woman who presented with purely digestive symptoms evolving for two years, with loss of appetite and deterioration of her general condition. The radiological assessment showed a pulmonary lesion with secondary hepatic and osseous nodules. A hepatic biopsy was performed and morphological and immunohistochemical results were compatible with an atypical bronchial carcinoid tumor, metastatic to the liver and bone.

Keywords: atypical; carcinoid tumor; case report; lung cancer; typical.

Figure 1. Thoracic CT scan (mediastinal window) showing a 3 x 3 x 2cm spiculated nodule (red arrow) of the right upper lung lobe.

Figure 2. Abdominal magnetic resonance imaging showing the presence of numerous hepatic metastatic nodules (red arrows). The largest one measured 3.5x3x3 cm

Figure 3. Abdominal CT scan performed to guide the hepatic nodule biopsy. The arrow shows the inserted biopsy needle.

Figure 4. Photomicrograph showing the presence of an epithelial proliferation made of sheets of moderately atypical cells. (HE, 200X) (A). An immunohistochemistry study revealed the expression of chromogranin A (B), synaptophysin (C), and TTF-1 (D) by the neoplastic cells.